1. Field of the Invention
This invention relates generally to education of medical professionals using medical simulators, more specifically to a method and apparatus for illuminating and recording an internal cavity of a medical simulator and integrating simulator data.
2. Background Information
I. Medical Simulator Background
It is highly desirable to train students in patient care protocols and proper use of specific medical devices before allowing contact with real patients. However, textbooks and flash cards lack the important benefits to students that can be attained from “hands-on” practice. Actual patients for such hands on training pose some difficulties, as can be expected. The training of medical personnel in the art of gynecological techniques or child-birthing, for example, is hampered by the unavailability of live patients willing to be practiced on and the undesirability of allowing untrained personnel from performing life-affecting, and possibly life-threatening, medical procedures.
Thus, patient care education has, in recent years, often been taught using devices, such as a manikin configured to simulate a patient, commonly called “medical simulators”, “patient simulators”, and “patient mannequins”, and “robotic patients” as well as simply “simulators” and “mannequins” (in context).
The presently available patient simulator mannequins provide “hands-on” training to medical personnel in areas such as trauma treatment, anesthesiology, gynecological examination, childbirth, and a host of other medical simulator specific procedures. These mannequins typically have significant physiologic mimicking capabilities. Various medical devices can be attached to these mannequins to train users in the proper implementation and use. These mannequins are often computer controlled and are programmed for a variety of responses which simulate medical conditions.
Using patient simulator mannequins, the students, nurses, medical personnel, etc. can learn medical protocols and develop skills in manual dexterity and proper placement of leads, tubes, etc. without risk to live patients.
One gynecological medical simulator, known as ZOE™ brand product, is disclosed in U.S. Pat. No. 5,472,345 and this is incorporated herein by reference. While this design has been described as an excellent model of a human female pelvis, it presents a few problems for the instructor as discussed in further detail below.
U.S. Pat. No. 7,465,168, incorporated herein by reference, owned by Birth Injury Prevention, LLC of Baltimore, Md. discloses a birthing simulator. Birthing is one physiological process that is useful to simulate. For instance, while the birthing process itself is a natural process that often concludes without complications, even in an uncomplicated birth, inaccurate obstetric procedure can cause injury to the fetus and to the mother. Moreover, while many births occur without complications, some births do not. Of the different types of complications that may occur, a number of them represent potentially life-threatening obstetric emergencies. Birthing simulators allow clinicians and researchers to research and train for complications and obstetric emergencies without risking fetal or maternal injury.
One approach to the use of patient mannequins was taken in U.S. Pat. No. 5,853,292, which is incorporated herein by reference, which discloses using sensor-equipped “virtual” instruments interfaced with a patient simulator through a computer interface module.
U.S. Pat. No. 6,535,714 relates to medical device training including providing for documentation of competency during the training exercise. This patent is incorporated herein by reference.
U.S. Pat. No. 6,428,323 discloses a system for teaching students and health care professionals medical examinations performed manually inside a body cavity or anatomical space. This patent is incorporated herein by reference.
U.S. Pat. No. 4,360,345, which is incorporated herein by reference, discloses a further simulator system for teaching cardiopulmonary resuscitation (CPR) and other basic physiological procedures. Gaumard Scientific Company, Inc. (Gaumard) of Miami, Fla. has developed a variety of medical simulators that are representative of the state of the art in medical simulators. Gaumard first introduced a basic childbirth simulator in 1949 and has over half a century of experience in the simulator field. The currently available NOELLE™ brand birthing simulator from Gaumard is a pregnant robotic simulator used in increasing numbers of medical schools and hospital maternity wards.
Further medical simulators and related devices described in U.S. Pat. Nos. 7,192,284; 7,114,954; 6,758,676; 6,527,558; 6,503,087; 6,503,087; 6,443,735; 6,193,519; 5,853,292 (discussed above); and 5,472,345 that are assigned to Gaumard. These patents are incorporated herein by reference.
Other examples of such patient mannequins are disclosed in U.S. Pat. Nos. 5,941,710; 5,900,923; 5,403,192; and 3,520,071, the disclosures of which are incorporated herein by reference.
The SIMMAN™ brand product is a portable and advanced patient simulator for team training in the emergency treatment of patients. The device is from Laerdal Medical, Inc. (Laerdal). The SIMMAN™ patient simulator has a realistic anatomy and clinical functionality and provides simulation-based education through realistic patient care scenarios. Laerdal further provides a PROMPT™ brand birthing simulator.
The Eagle Patient Simulator, developed by David Gaba, Md., and others, at Stanford University, and marketed by MedSim, Inc. of Ft. Lauderdale, Fla., connects to an interface cart that drives the mannequin's electromechanical functions. The cart also serves as the interface for conventional monitoring equipment found in the operating room.
The G. S. Beckwith Gilbert and Katharine S. Gilbert Medical Education Program in Medical Simulation is a resource for all Harvard Medical School students and faculty. The Gilbert Program integrated learning labs are each equipped with a realistic mannequin patient simulator, a seminar table with whiteboard, and a web-connected plasma display. This unified learning lab brings together traditional teaching and web-based information technology all at the bedside of a simulated patient. The mission of the G. S. Beckwith Gilbert and Katharine S. Gilbert Medical Education Program is to “bring to life” good teaching cases for medical students of all levels using high-fidelity patient simulation to foster experiential learning in a safe environment”
II. Recorded Medical Simulator Sessions
The realism of the patient simulators represents only one portion of the entire medical patient simulator educational experience. It is common for the simulation events to be monitored and even recorded, typically on video-tape or via a hand held video recorder, for peer or teacher review. This critical review and feedback of a session is as important of a teaching tool as is the simulation itself.
In such analysis and feedback of given simulation sessions, the trainees can have mistakes pointed out and corrected. Conventionally this entails that the entire event is recorded on a camera for playback. The recording of the event is particularly useful in simulations where there are multiple participants, i.e. a “team” of participants, that may have overlapping spheres of influence, and the event recording is the only effective review of the team interaction to review how the team worked together. The simulator itself will often have a recording of the changes in all of the particular simulated physiologic parameters of the simulator (i.e. the data output) over the time of the session for latter analysis, whereby there is an objective review of the session on the simulator (e.g., how did the simulated patient do throughout the event).
The data output record of a session alone does not provide adequate information as to why a particular patient result was achieved in a session, particularly in a team participant environment with overlapping areas of influence relative to the simulated physiologic parameters of the simulator. A video and an audio recording of the event does add the ability to review why a particular result was or was not achieved in a session with the patient simulator.
In 2003, the Peter M. Winter Institute for Simulation, Education and Research (WISER), a simulation center located at the University of Pittsburgh Medical Center (UPMC), attempted to utilize the Laerdal SIMMAN™
Simulator to generate Extensible Markup Language (XML) performance logs of simulation sessions that could then be utilized to correlate with a digital primary video file. The digital video recording was stored on a central server with playback made available over the Internet via a standard web browser. The time stamp on the performance log was attempted to be utilized as an index mechanism for the primary video file. This early synchronizing system never proved to be effective in practice, however, and the attempted integration was not sufficient to be a meaningful tool for students. The proposed system did not offer independent control over various inputs.
KB Port, LLC. (KB Port) of Pittsburgh, Pa. currently provides a system for effectively synchronizing the video, audio recordings and data log files for analysis and for playback (feedback). The KB Port ETC™ brand system can take multiple video and audio input signals and effectively synchronize these with multiple data inputs of medical simulators for integrated playback. The 2008 version of the ETC™ product provides a seamless integration of video and audio and data inputs and it is this system that is particularly helpful in implementing the aspects of the present invention as described below. The operating aspects of the ETC™ product are described in U.S. Patent Publication No. 2008-0124694 which is incorporated herein by reference.
Within the meaning of this application, the ETC™ system is a type of synchronizing system, wherein a synchronizing system is a system that can receive a variety of independent time based inputs, including audio and visual inputs, for storage and provide for playback of the inputs in an integrated, synchronized manner.
III Visual Observation of Internal Cavity of Medical Simulators
It has been noted that there exists a problem with medical techniques performed in internal cavities of medical simulators. For example in discussing the drawbacks of the simulator disclosed in U.S. Pat. No. 5,472,345, the hands of the person performing the exam on the simulator are not visible to an observer; a student watching an instructor does not obtain a clear picture of basic internal exam technique, nor is an instructor able to accurately judge a student's performance. Some simulators thus have been designed with a transparent region to allow viewing of the internal region, or even a cut-away portion to show the internal cavity. The provision of a transparent portion or cut-away portion of a manikin eliminates some of the realism of the manikin, allowing the students to practice with a field of view not afforded them in real life. Even with a cut-away or transparent region or suitable internal lighting, the simulator cannot significantly overcome the problem of limited visibility. Without detailed feedback, the student may not learn the essential elements of the exam or may develop improper technique. Unfortunately, the prevailing attitude in medical schools is that this type of manual exam is eventually learned through experience, and educators tend to tolerate the above problems.
In addressing the deficiencies of U.S. Pat. Nos. 5,472,345, 6,428,323, both of which are incorporated herein by reference, discloses the use of a variety of internal sensors that give some type of feedback of the trainee's performance of a given medical procedure (i.e. gynecological examination) within an internal cavity of the medical simulator. U.S. Pat. No. 6,428,323 suggests that earlier medical simulator systems do not provide information on exams performed manually inside body cavities of the simulators, and thus there was no efficient means for assessing exam performance.
As noted above, in an attempt to partially address these concerns, medical simulators have provided internal cavities with transparent sections or removable covers (also called cut-away sections) to allow for direct viewing of the now opened cavity and recording of the same with external video cameras. This has been helpful to begin to prepare the students in particular procedures or medical protocols, but it allows the students an increased visibility that is not present in the actual procedure and can be detrimental in learning proper protocols as the students improperly rely upon the visualization of the cavity that is provided on in these simulators.
There remains a need in the industry to provide an unobtrusive video recording of an internal cavity of medical simulator and to integrate such recording with other data from the simulator. There is a further need to address the deficiencies of the prior art in a cost effective manner.